SERIP & Medicare What are your options if you drop your State of Iowa Retiree Insurance? Presented by Senior Health Insurance Information Program Iowa Insurance Division 1-800-351-4664
What is SHIIP? Objective Information Source Part of the State of Iowa Insurance Division Answers questions and provides assistance Doesn t recommend or endorse specific companies, products or agents 2
Medicare Eligible Retired & No Working Spouse Medicare is your primary coverage. Need to enroll in Medicare Part A and Part B. Enrolling in Part B later can result in higher premium and a wait before getting coverage. Retirement health coverage from employer will pay after Medicare. 3
Medicare Eligible - Your Spouse Works Do you have access to coverage through your spouse s employer plan? You don t need to enroll in Medicare Part B if covered through employer health insurance Already enrolled in Part B, can suspend until spouse retires When spouse retires you must enroll in Part B to avoid penalty 4
What are your options if you drop your State Retiree Insurance? Two Options Original Medicare Medicare Advantage Medicare Supplement No Supplement Includes Part D Part D Plan 5
OPTION 1 - Enroll in a Medicare Supplement and a Part D plan Enroll in a Medicare Supplement: Medicare Supplement Insurance Health Insurance policies sold by private insurance companies Also called Medigap Covers gaps in Original Medicare 10 Standardized policies Plans A, B, C, D, F, G, K, L, M, N Costs may vary By plan By company Where you live Your gender 6
Medicare Supplement -Standard Plans Ten Benefit Packages SHIIP Counselors can help you compare and evaluate your options 7
Guaranteed Right Open Enrollment Available at age 65 or older Triggered when Medicare Part B first starts Lasts six months from Part B effective date Can t be turned down Can t be charged higher premium because of health history 8
Medicare Supplement Insurance You have a Guaranteed Right to purchase a Medicare Supplement if: It has been less than six months since you turned 65 and enrolled in Medicare Part B What does this mean? You cannot be turned down for any Medicare Supplement being sold in Iowa. 9
Medicare Supplement Insurance You will be subject to underwriting when you purchase a Medicare Supplement if: It has been more than six months since you signed up for Part B. What does this mean? The insurance company may refuse to sell you a policy or charge a higher premium because of health reasons. You should allow up to 30 days to be approved. 10
Waiting period for Pre-Existing Conditions A waiting period is a period of time when an insurance company can deny payment of benefits for pre-existing conditions. Maximum of six months A pre-existing condition under the Iowa Insurance Code: One for which advice was given or treatment recommended within six months before the effective date of coverage 11
How can you avoid a waiting period for Pre-Existing Conditions? You can avoid a pre-x if you: Apply for a Medicare Supplement during your Medicare Supplement open enrollment period within 63 days of the end of previous health insurance coverage OR Look for a Medicare Supplement that does not have a waiting period before pre-existing conditions are covered 12
OPTION 1 - Enroll in a Medicare Supplement and a Part D plan Enroll in a Medicare Part D plan: You have a two-month Special Enrollment Period to enroll in a Medicare Part D plan if you drop your State of Iowa retire coverage Starts when State coverage ends If you don t join a Part D plan or have other creditable drug coverage Pay a late enrollment penalty if you join at a later time Can change every year between Oct 15 Dec 7 SHIIP Counselors can help you compare Part D plans 13
OPTION 2: Enroll in a Medicare Advantage Plan Enroll in a Medicare Advantage: You have a two-month special enrollment period when your State of Iowa retiree coverage ends Most plans include Part D coverage so Don t need a separate Part D plan Don t need a Medicare Supplement Opportunity to change plans every year 14
OPTION 2: Enroll in a Medicare Advantage Plan Medicare Advantage A Private Solution Medicare contracts with a private company on an annual basis Plan can renew, change or terminate at end of contract year Must provide Medicare Part A and Part B services Must cover emergency care out-of-network The plan handles the claims Use network providers/providers who accept MA plan 15
Medicare Advantage Eligibility Have Medicare Part A and Part B Do not have end-stage renal disease Live in service area 16
Medicare Advantage Costs Must still pay the Part B premium May pay additional monthly premium Pay other out-of-pocket costs Different from Original Medicare Plan Vary from plan to plan Some have additional benefits 17
Medicare Advantage Types of Plans Medicare Advantage Plans: HMO Health Maintenance Organization PPO Preferred Provider Organization Private Fee-For-Service Special Needs Plans Must meet plan criteria to enroll Other Health Plans: Cost Plan Available in Dubuque area Continuous enrollment Need to enroll in a Part D plan 18
Medicare Advantage - Things to consider before you enroll Will your doctors, hospitals and other providers accept the plan? If you are considering a PPO: Ask if your providers are in-network or out-of-network Your costs may be more if your provider accepts the plan but is out-of-network What are the deductibles, copayments or coinsurance for the benefits I m most likely to use? What is the annual out-of-pocket maximum? What is the premium? Do I live in the service area for the plan? Does the plan include drug coverage? 19
Contact SHIIP Statewide : 1-800-351-4664 (TTY 1-800-735-2942) Website: E-mail: www.therightcalliowa.gov shiip@iid.iowa.gov Resources to help you make important Medicare Decisions: Guides: Iowa Medicare Supplement and Premium Comparison Guide Medicare Advantage & Other Health Plans in Iowa Guide SHIIP Counselors can help you: Understand your Medicare benefits Compare and evaluate Medicare Supplement policies Understand and compare Medicare Advantage plans Compare Medicare Part D plans 20